Management outcome of pediatric wilms’ tumor and factors Affecting the outcome, in jumc pediatric oncology ward, a 5 year Retrospective study

Abstract

Background: Like most pediatric malignancies, a survival rate of Nephroblastoma Wilms’ tumor (WT) patient has noticeably improved with modern multidisciplinary cancer management. WT survival rates as reported in large trials conducted in high-income countries generally approach 90%and 70% for metastatic disease whereas in sub-Saharan Africa it is compromised by resource deficiencies with most studies reporting less than 50% survival at 5 years. This study aimed to assess theclinical outcome and different factors that influence treatment outcome of pediatric WT cases treated at Jimma University Medical Center (JUMC), Jimma, Southwest Ethiopia. Methods: Thiswas a retrospective study. The medical records of pediatric patients aged less than 14 years who were treated for WT in JUMC from January 2017 to December 2021 were reviewed. Patient’s sociodemographic, clinical, radiological, tumor histology and clinical stage, and treatment data were collected with a pretested structured questionnaire by a trained data collector. Descriptive statistical analysis and chi-square test was made with SPSS version 26. Associations were considered statistically significant with a p-value less than 0.05. The1-year survival was estimated. Results: A total of 46 children were diagnosed with WT during the study period.Three patientswere excluded from the study because three of them didn’t receive any form of therapy and had incomplete data. Forty-three patients were included in the study with median age at diagnoses was 36 months and the mean was 45.2 months (range 5–156). Twenty-eight patients were males and 15 females,and males were almost twice affected. Abdominal swelling/mass was the commonest presentation (93%).Twenty-three patients (53.5%) had locally advanced disease, 4 (7%) patients had disseminated disease to the liver and lungs and the rest had localized disease. Treatment offered was in accordance with the Societe Internationale d’ Oncologie Pediatrique (SIOP) protocol; 39 were operated.Seventeen of39 operated patients had documented histologic report. All patients, except one, had favorable histology Wilms tumor.Intraoperative incidents had occurred in 5 patents. Only 16 out of 43 patients achieved complete response of the tumor after combined treatment with surgery and chemotherapy.Nine of 43patients (21%) experienced events during the study period including5 relapsesand 4deaths.The doses of chemotherapy received after surgery had statistically significant association with the OS and EFS(p=0.026). Kaplan-Meier method was applied to estimate the probability of EFS and OS.EFS was measured from date of diagnosis - 8 - of treatment failure or last follow-up and OS was measured from date of diagnosis to death and lost to follow-up. The 1-year event free and overall survival in those who took more than average cycles of chemotherapy were between 35 and 50% and between 20 and 40% respectively. Conclusion: The main reason for poor outcome in patients with Wilms tumor was not receiving chemotherapy after surgery. Doses of chemotherapy received after surgery significantly affected treatment outcomes (p=0.026). Age at diagnosis, sex, duration of symptoms, stage at diagnosis, and the protocol used did not predict survival